UTI in Nursing Home Residents: Research Training and Clinical Investigation

描述(由申请人提供)：改善老年人的医疗保健服务需要训练有素的老年医生和专注于老年病的专科医生进行调查。老年人的感染是一个常见的公共卫生问题，会导致功能衰退、死亡率和医疗保健支出。疗养院居民尤其是弱势群体，有必要对他们进行进一步调查，以优化医疗保健。养老院居民的尿路感染(DTI)是一个调查研究不足的话题。该应用程序的主要目标是培训候选人Juthan i-Mehta博士成为老年传染病研究的领导者，并在疗养院居民中推进尿路感染的多学科计划研究。 职业发展计划的短期目标是：1)在传染病、老年医学和疗养院实践之间建立一个以病人为导向的调查员；2)在慢性病流行病学、传染病流行病学和纵向研究设计方面获得额外的培训和指导；以及3)在疗养院获得临床试验设计、老年医学和感染控制方法方面的技能，这将是未来研究所必需的。长期目标是将候选人培养成老年人感染领域的研究领导者，准备在长期护理设施中进行多中心观察性和干预性临床试验。该研究计划的具体目的是：1)确定护理人员对疑似UTI患者的UTI特异性临床特征(例如臀部疼痛或压痛)以及UTI非特异性临床特征(例如精神状态的变化)的可靠性；2)确定疑似UTI患者中与UTI实验室证据相关的可靠临床特征(即菌尿和脓尿)，以创建一个基于证据的UTI定义；以及3)在一项单独的疗养院居民UTI疑似病例验证队列中，验证既可靠且与UTI实验室证据相关的UTI临床特征的组合。候选人是一位新兴的以患者为导向的调查员，在传染病和老年临床流行病学方面接受过独特的培训，这使她成为该领域调查领导者的理想候选人之一。她召集的知名导师和耶鲁大学的环境将使她能够进行出色的培训，并成功完成拟议中的研究。

DESCRIPTION (provided by applicant): Improving health care delivery for older adults requires investigation by both trained geriatricians and subspecialists with a geriatric focus. Infections in older adults are a common public health problem that lead to functional decline, mortality, and healthcare expenditures. Nursing home residents, in particular, are a vulnerable population in whom further investigation is warranted to optimize medical care. Urinary tract infection (DTI) in nursing home residents is an investigatively understudied topic. The primary goal of this application is to train Dr. Juthani-Mehta, the candidate, to be an investigative leader in geriatric infectious diseases and to advance multidisciplanary research in UTI in nursing home residents. The short-term goals of the career development plan are: 1) to establish the candidate as a patientoriented investigator at the interface of infectious diseases, geriatric medicine, and nursing home practice; 2) to gain additional training and mentorship in chronic disease epidemiology, infectious diseases epidemiology, and longitudinal study design; and 3) to obtain skills in clinical trial design, geriatric medicine, and infection control methodology in nursing homes that will be necessary for future studies. The long-term goal is to train the candidate to be an investigative leader in the field of infections in older adults prepared to conduct multi-center observational and interventional clinical trials in long-term care facilities. The specific aims of the research plan are: 1) to determine the reliability of UTI specific (e.g. flank pain or tenderness) and UTI non-specific (e.g., change in mental status) clinical features as assessed by nursing staff in nursing home residents with suspected UTI; 2) to identify those reliable clinical features in residents with suspected UTI that are associated with laboratory evidence of UTI (i.e., bacteriuria plus pyuria) to create an evidencebased definition of UTI; and 3) to validate the combination of clinical features that are both reliable and associated with laboratory evidence of UTI in a separate validation cohort of nursing home residents with suspected UTI. The candidate is an emerging patient-oriented investigator with unique training in infectious diseases and geriatric clinical epidemiology that make her an ideal candidate to be among the investigative leaders in this field. The renowned mentors she has assembled and the environment at Yale University will allow for outstanding training and the successful completion of the proposed study.